"If you can't describe what you are doing as a process, you don't know what you're doing." -W. Edwards Deming
So, you’ve concluded it’s time for a billing service. It wasn’t an easy decision. You may have wrestled with the idea of putting your future in the hands of strangers – expert strangers, but strangers nonetheless, or struggled with honest feelings of loyalty to billing staff, who, their RCM shortcomings notwithstanding, are devoted employees doing their best. You did the math a hundred times, and discovered the real cost of billing internally is a lot higher than you originally thought, and the EHR that was supposed to include a billing solution didn’t really perform as you hoped.
You interviewed several RCM firms, called references, slept on it, talked to them again, and slept on it some more. You made your decision, the attorney approved the contract (with a few revisions), and despite some lingering doubt, you signed the agreement. You’re committed.
You’ve talked to your staff and re-assured them that no one is losing their job. Or, you let some bad actors go. Either way, you’ve made some hard choices for the health of your practice and the good of your family. You did all your homework and made an informed, rational decision.
Congratulations! ...now what?
Onboarding can feel a bit like the dog training the human, and may initially seem like you are training the billing company. It is important to know that the onboarding process, while being largely templated, is unique for each new relationship. From the vendor’s perspective, there are myriads of tasks to complete, and virtually no room for error. I like to point out that when a new landscaping company makes a mistake, the grass grows back with no real harm done; when errors in the onboarding process happen, doctors lose money.
Onboarding is the process through which providers and their RCM company transition billing efforts from in-house (or from another billing company) to the new company. Typically onboarding - from commencement to fully realized cash flow - takes about six months.
We can’t tell you much about how other companies do it; nor can we speak to their success rates. We can only discuss our processes and offer them as a guide for the way things ought to be. A summary of The Billing Pros’ Strategic Onboarding Plan follows.
Step 1. The planning meeting. To ensure a smooth, successful transition, you will want to jointly develop a working timeline and verify expectations and responsibilities for the relationship. Imagine all of the information your current billing office uses to successfully bill a claim (including the knowledge lost via turnover) and all of the pieces that fit together, and you will get an idea of the information your new billing company needs. It can be exhausting, but you should come out of the meeting feeling great about how you’re working together to achieve the best possible results. For a sample agenda, click here.
Step 2. System configuration. Following the planning meeting, your new RCM firm will begin setting up the PM/billing software for successful billing. Despite efforts to cover everything in the planning meeting, you will be working closely with key people to make sure everything is ready.
Step 3. Meet your team. The billing service will make final staff assignments and make the proper introductions. Ideally, you will have a team leader who will serve as you contact for all billing and A/R matters, but you will want to be on a first name basis with your primary charge entry and payment specialists also.
Step 4. Work and wait. When done properly, onboarding a new practice takes time. Rushing things at this stage invites cash flow problems later – something no one wants. Keep that in mind with a billing vendor tells you they can start in two weeks. A meticulous partner will painstakingly complete and tweak your system configuration, develop workflows, and test interfaces and claims submission.
If your RCM service is credentialing your providers, be patient. Remember, you’re having someone else do it because you know how tedious and labor intensive physician enrollment can be. Still, don’t assume anything and check with your primary contact regularly to establish that all is progressing as expected.
Step 5. Test everything. Confirm with your billing partner that electronic and paper claims output, software interfaces, clearinghouse submissions and returned data, patient statements and account follow up letters are all verified for content and function.
Step 6. Go live! By this point your RCM partner should be fully invested in your success and fully ready to perform. Both you and your billing service should have a strong sense that you are where you ought to be. Everyone has left as little as possible to chance and now it’s time to trust your work.
Step 7. Inspection and Expectations. Competent RCM partners will pay close attention to source documentation, workflow, production statistics, EDI issues, reimbursement data, and KPIs. As your A/R builds, you should have access to patient accounts, on-demand reporting, and EOM reports. Building your A/R pipeline takes time, and it will likely be five to six months before collections normalize. You will likely experience a moderate drop in monthly cash flow as the A/R builds and the old receivables dwindle (assuming they are being worked), and it will be helpful to take the long view.
Every stakeholder wants a good start and a long and happy relationship, and good communication will go a long way toward calming onboarding jitters. If you have a question or you aren’t clear about any point of the process, pick up the phone and call your RCM partner. They are there to help.